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As a Hepatologist (liver specialist) and Gastroenterologist, Dr. Galati is trained to perform a wide range of procedures.

In most cases, this procedure is done on an out-patient basis. In cases of severe obesity, heart, lung, or kidney disease, it may have to be performed in a hospital setting (though still out-patient).

In all cases, the patient must be accompanied by a responsible adult, to assist in traveling to and from the unit. Anesthesia will be administered, and legally our patients must be accompanied. You WILL NOT be allowed to drive home yourself, and can only resume driving after 24 hours.

Upper Endoscopy

Indication

Upper endoscopy is performed to evaluate problems related to the upper digestive tract, including the esophagus (the food pipe), stomach, and small intestine. Upper endoscopy (EGD) can provide valuable diagnostic information on the following disorders including upper abdominal distress, abdominal pain, nausea, and vomiting, especially that persisting after an appropriate trial of therapy, persistent esophageal reflux symptoms, also known as GERD, despite appropriate therapy, swallowing difficulties, persistent vomiting or nausea of unknown cause, X-ray findings of a tumor in the esophagus, stomach, or small intestine, X-ray findings of gastric or esophageal ulcer, evidence of a narrowing of the esophagus, to assess for malignancy, gastrointestinal bleeding, and to determine the presence of esophageal varicies in patients with cirrhosis and portal hypertension.

EGD is also used for periodic surveillance in patients with Barrett's esophagus, in which the abnormal esophageal surface lining carries an increased risk of malignancy. This condition usually developed in individuals with longstanding reflux and heartburn. Similarly, patients with adenomatous gastric polyps are at increased risk for cancer, and periodic endoscopy is warranted. Follow up EGD is also indicated in selected patients with large esophageal, gastric or stomach ulcers to demonstrate healing.

For patients with liver disease and cirrhosis, screening for esophageal or gastric varices is performed with and upper endoscopy (EGD). 

Preparation

Prior to the procedure, you will need to be on an empty stomach. This allows for the best and safest examination. Typically, you’ll be asked not to take any food or liquids after midnight. In most cases, you will be instructed not take your morning medications. Diabetic patients will need to receive special instructions on their insulin dosing prior to the procedure. Your usual morning medications can be taken soon after the procedure is completed. Also, alert your doctor if you require antibiotics prior to undergoing dental procedures, because you might need antibiotics prior to upper endoscopy as well.

Upon arrival to the outpatient and patient registration areas, you will be taken to the “pre-op” area, where you’ll be greeted by a nurse, who will review your medical history, medications, and questions you may have prior the procedure. The nurse will also review the informed consent for the procedure you will need to sign. Because anesthesia will be used, a small intravenous catheter will be placed. You will also be evaluated by an anesthesiologist. 

You will be moved on the stretcher to the procedure room, where you will continue to be monitored. Your blood pressure, heart rate, oxygen saturation, and respiratory status will be monitored continuously. Dr. Galati's team will administer anesthesia, consisting of propofol. If you have a prior allergy to these medications, other similar medications will be substituted.

Procedure

Prior to the procedure, premedication to minimize gagging and enhance patient comfort is used for most examinations. This typically consists of topical pharyngeal anesthesia by spray or gargle and intravenous sedation as noted above. The latter is given slowly and titrated according to the response of the patient.

During the procedure a gastrointestinal assistant and nurse monitors your overall clinical status and comfort level and provides technical assistance to Dr. Galati. You will be positioned on your left side on the examining table. A small plastic bite block will be placed in your mouth to prevent and damage to the instrument or your teeth. The flexible endoscope is guided carefully through the mouth and the patient is instructed to swallow while gentle pressure is applied. The instrument is then passed under direct vision through the esophagus and stomach and generally into the small intestine. Careful inspection of the mucosal surface of the gut is performed, both during scope insertion and during its slow withdrawal. Documentation of findings may be recorded with photographic or video techniques. Channels running through the scope will enables Dr. Galati to obtain biopsy of abnormal areas of interest, or other specimens, or to perform therapeutic procedures such as electrocoagulation, injection sclerotherapy, tumor ablation, foreign body removal, or banding of esophageal varicies.

The procedure usually requires 10-20  minutes. At its conclusion the patient is observed during an additional 30 to 60 minute recovery period. When fully awake, the patient is discharged with instructions for follow-up.

Complications

Upper endoscopic procedures (EGD) are relatively safe procedures. Major complications may include bleeding, perforation, aspiration pneumonia, or cardiac events. Large surveys indicate a risk of serious complications during diagnostic EGD of approximately 1 in 800 and a risk of death of approximately 1 in 5,000. In more seriously ill patients, such as those for whom EGD is performed to evaluate active bleeding at the time of the procedure, the risks are higher. In one such series, 1 in 200 patients had major complications of the procedure and the risk of death was 1 in 700. Because of its relative safety, EGD is usually substituted for X-ray in the evaluation of gastrointestinal symptoms in women who may be pregnant.